Медицинская литература. Новинки

 

 

 

 

 

 

Возможности магнитнорезонансной томографии в оценке состояния регионарных лимфатических узлов у больных раком шейки матки и эндометрия

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Целью исследования являлось изучение возможностей МРТ в предоперационной оценке состояния регионарных лимфатических узлов при раке шейки матки и раке эндометрия. Материал и методы. В исследование включены 303 пациентки, из них 253 больные раком шейки матки и 50 больных раком эндометрия. Метастатическое поражение лимфатических узлов по данным морфологического исследования было установлено у 46. С целью определения стадии опухолевого процесса всем пациенткам в предоперационном периоде проводилась МРТ. Результаты МРТ были сопоставлены с данными послеоперационного гистологического исследования. Результаты. Диагностическая ценность МРТ в оценке состояния тазовых лимфатических узлов у больных раком матки составила: чувствительность – 61%, специфичность – 90%, точность – 86%, прогностическая ценность положительного результата – 53% и прогностическая ценность отрицательного результата – 93%. Выводы. Адекватное установление стадии заболе вания на момент постановки диагноза является важнейшим аспектом успешного ведения больных раком матки и способствует оптимальному планированию лечения. Обладая достаточно высокой информативностью в диагностике метастатического поражения лимфатических узлов при раке шейки матки и раке эндометрия, являющегося фактором неблагоприятного прогноза, МРТ способствует индивидуализации к подходам лечения, что положительно отражается на его результатах.

Ключевые слова:
МРТ, рак шейки матки, рак эндометрия, определение стадии, лимфатические узлы.

Литература:
1. Hricak H., Husband J., Panicek D.M. Oncologic imaging:
Essential of reporting common cancer. Philadelphia:
Saunders (Elsevier Inc.), 2007.
2. Чиссов В.И., Старинский В.В., Петрова Г.В. и др. Состояние онкологической помощи населению Российской Федерацию. М.: РИИС ФИАН, 2010.
3. Руководство по онкологии; Под ред. В.И. Чиссова,
С.Л. Дарьяловой. М.: МИА, 2008. 518–540.
4. Hulse P., Carrington B. MRI manual of pelvic cancer.
London; New York: Martin Dunitz Taylor & Francis group,
2004.
5. Онкогинекологический атлас: Пер. с англ. под ред.
Е.Г. Новиковой. М.: Практическая медицина, 2010.
11–27.
6. Pakkal M.V., Rudralingam V., McCluggage W.G. et al. MR
staging in carcinoma of the endometrium and carcinoma
of the cervix. Ulster Med. J. 2004; 73 (1): 20–24.
7. Selman T.J., Mann C.H., Zamora J. et al. A systematic
review of tests for lymph node status in primary cervical
cancer. BMC Womens Hlth 2009; 5: 81–88.
8. Selman T.J., Mann C.Р., Zamora J. et al. Diagnostic accuracy of tests for lymph node status in primary cervical
cancer: a systematic review and metaanalysis. Canad.
Med. Assoc. J. 2008; 178 (7): 855–862.
9. Bipat S., Glas A.S., Zwinderman A.H. Computed tomography and magnetic resonance imaging in staging of uterine cervical carcinoma: a systematic review. Gynecol Oncol.
2003; 86 (5): 31–37.
10. Boss E.A., Barentsz J.O., Massuger L.F. et al. The role of
MR imaging in invasive cervical carcinoma. Eur. Radiol.
2000; 10 (2): 256–270.
11. Park W., Park Y. J., Huh S. J. et al. The Usefulness of MRI
and PET Imaging for the Detection of Parametrial Involvement and Lymph Node Metastasis in Patients with
Cervical Cancer. Jap. J. Clin. Oncol. 2005; 35 (5): 260–264.
12. Cabrita S., Rodrigues H., Abreu R. et al. MRI in preoperativestagingof endometrial carcinoma. Eur. J. Gynecol.
Oncol. 2008; 29 (2): 135–137.
13. Cho H., Kim Y.T., Kim J.H. Accuracy of preoperative tests
in clinical stage I endometrial cancer: the importance of
lymphadenectomy. Acta Obstet. Gynecol. Scand. 2010;
89 (2): 175–181.
14. Choi H.J., Kim S.H., Seo S. et al. MRI for Pretreatment
Lymph Node Staging in Uterine Cervical Cancer. Am. J.
Radiol. 2006; 187: 538–543.
15. Han S.S., Lee S.H., Kim D.H. et al. Evaluation of preoperative criteria used to predict lymph node metastasis in
endometrial cancer. Acta Obstet. Gynecol. Scand. 2010;
89 (2): 168–174.
16. Hawnaur J.M., Johnson R.J., Buckley C.H. et al. Staging,
volume estimation and assessment of nodal status in carcinoma of the cervix: comparison of magnetic resonance
imaging with surgical findings. Clin. Radiol. 1994; 49 (7):
443–452.
17. Hong K.S., Ju W., Choi H.J. et al. Differential diagnostic
performance of magnetic resonance imaging in the
detection of lymph node metastases according to the
tumor size in earlystage cervical cancer patients. Int. J.
Gynecol. Cancer. 2010; 20 (5): 841–846.
18. Ivanov S. Methods for preoperative and intraoperative
evalution of the tumor infiltration and lymph node metastases in endometrial cancer (summarized own and foreing
experience). Akush. Ginecol. Sofiia. 2010; 49 (4): 21–24.
19. Koh D.M., Thoeny H.C. Diffusionweighted MR Imaging
Application in the body. Berlin; Heidelberg: Springe-Verlag, 2010.
20. Kim S.K., Choi H.J., Park S.Y. et al. Additional value of
MR/PET fusion compared with PET/CT in the detection of
lymph node metastases in cervical cancer patients. Eur. J.
Cancer. 2009; 45 (12): 2103–2109.
21. Lin G., Ho K.C. Wang J.J. et al. Detection of lymph node
metastasis in cervical and uterine cancer by diffusionweighted magnetic resonance imaging at 3T. J. Magn.
Reson. Imaging 2008; 28: 128–135.
22. Mitchell D.G., Snyder B., Coakley F. et al. Early Invasive
Cervical Cancer: MRI and CT Predictors of Lymphatic
Metastases in the ACRIN 6651 / GOG 183 Intergroup
Study. Gynecol. Oncol. 2009; 112 (1): 95–103.
23. Park J.Y., Kim E.N., Kim D.Y. et al. Comparison of the
validity of magnetic resonance imaging and positron emission tomography/computed tomography in the preoperative evaluation of patients with cervical cancer. Gynecol.
Oncol. 2008; 108 (3): 486–492.
24. Park S.O., Kim J.K, Kim K.A. et al. Relative apparent diffusion coefficient: determination of reference site and validation of benefit for detecting metastatic lymph nodes in
uterine cervical cancer. J. Magn. Reson. Imaging 2009;
29: 383–390.
25. Reinhardt M.J., EhrittBraun C., Vogelgesang D. et al.
Metastatic Lymph Nodes in Patients with Cervical Cancer:
Detection with MR Imaging and FDG PET. Radiology 2001;
3: 776–782.
26. Rockall A.G., Sohaib S.A., Harisinghani M.G. et al.
Diagnostic perfomance of nanoparticleenhanced MRI in
the diagnosis of lymph node metastases in patients with
endometrial and cervical cancer. J Clin. Oncol. 2005;
23 (12): 2813–2821.
27. Selman T.J., Mann C., Zamora J. et al. Diagnostic accuracy of tests for lymph node status in primary cervical cancer: a systematic review and metaanalysis. Canad. Med.
Assoc. J. 2008; 178 (7): 855–862.
28. Selman T.J., Mann C.H., Zamora J. et al. A systematic
review of tests for lymph node status in primary cervical
cancer. BMC Womens Hlth 2009; 5: 81–88.
29. Xue H.D., Li S., Sun H.Y. et al. Clinical application of body
diffusion weighted MR imaging in the diagnosis and preoperative N staging of cervical cancer. Chin. Med. Sci. J.
2008; 23: 133–137.

The Usefulness of MRI for Pretreatment Lymph Node Staging in Uterine Cervical and Endometrial Cancer

Objective. The purpose of this study is to elucidate the usefulness of magnetic resonance imaging (MRI) in the preoperative assessment of the status of regional lymph nodes in cervical cancer and endometrial cancer. Materials and methods. The study included 303 patients: 253 patients with cervical cancer and 50 patients with endometrial carcinoma. Metastases in regional lymph nodes were detected in 46 cases. For the preoperative staging MRI was performed for all patients. MRI resultswerecomparedwiththedataofthepostoperativehistologicalstudy. Results. The accuracy, sensitivities and specificities were of MRI for pretreatment staging to identify lymph node metastasis in patients with cervical and endometrial cancer were 61, 90 and 88%, positive predictive values and negative predictive values were 53 and 93% respectively. Conclusions. Accurately stage the disease at the time of diagnosis is the most important aspect of successful management of patients with cancer of the uterus, promotes optimal planning of treatment. With rather high informative in diagnosis of metastatic lymph node in patients with cervical and endometrial cancer – one of the most important prognostic factors, MRI contributes to the individualization of approaches to the therapy and allows to achieve successful results of treatment.

Keywords:
MRI, recurrent tumor, endometrial cancer, cervical cancer, staging, lymph nodes